title: Elephant-to-human transmission of tuberculosis, 2009.
abstract: In 2009, the Tennessee Department of Health received reports of 5 tuberculin skin test (TST) conversions among employees of an elephant refuge and isolation of Mycobacterium tuberculosis from a resident elephant. To determine the extent of the outbreak and identify risk factors for TST conversion, we conducted a cohort study and onsite assessment. Risk for conversion was increased for elephant caregivers and administrative employees working in the barn housing the M. tuberculosis-infected elephant or in offices connected to the barn (risk ratio 20.3, 95% confidence interval 2.8-146.7). Indirect exposure to aerosolized M. tuberculosis and delayed or inadequate infection control practices likely contributed to transmission. The following factors are needed to reduce risk for M. tuberculosis transmission in the captive elephant industry: increased knowledge about M. tuberculosis infection in elephants, improved infection control practices, and specific occupational health programs.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA. zle9@cdc.gov
authors.forename: Rendi
authors.initials: R
authors.lastname: Murphree
authors.forename: Jon V
authors.initials: JV
authors.lastname: Warkentin
authors.forename: John R
authors.initials: JR
authors.lastname: Dunn
authors.forename: William
authors.initials: W
authors.lastname: Schaffner
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D004196:Disease Outbreaks; D004606:Elephants / Q000382:microbiology*; D005260:Female; D006801:Humans; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D016273:Occupational Exposure; D016272:Occupational Health; D013714:Tennessee / Q000453:epidemiology; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D055815:Young Adult; D015047:Zoonoses / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*